<?php 
include_once('connection/connection.php');
//include('header.php');
//include('menu.php');
$src=$_REQUEST['src'];
$habit=$_REQUEST['habit'];
$loc_id=$_REQUEST['loc_id'];
?>
<html>
<head>
<meta http-equiv="Content-Language" content="en-us">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<link href="html_file/New Folder/css/style_question.css" type="text/css" rel="stylesheet" />
<title>Survey Form</title>
<body>
<?php
if(isset($_POST['submit']))
{
	$_SESSION['success_rain'] = 1;
		$fclick = true;
		//$loc_id = $_SESSION['loc_id'];	
		$risk_q1=$_POST['risk_q1'];
		$risk_q2=$_POST['risk_q2'];
		$risk_q3=$_POST['risk_q3'];
		$risk_q4=$_POST['risk_q4'];
		$risk_q5=$_POST['risk_q5'];
		$risk_q6=$_POST['risk_q6'];
		$risk_q7=$_POST['risk_q7'];
		$risk_q8=$_POST['risk_q8'];
		$risk_q9=$_POST['risk_q9'];
		$risk_q10=$_POST['risk_q10'];
		$risk_q11=$_POST['risk_q11'];
		$risk_q12=$_POST['risk_q12'];
		$risk_q13=$_POST['risk_q13'];
		$risk_q14=$_POST['risk_q14'];
		$risk_q15=$_POST['risk_q15'];
		$risk_q16=$_POST['risk_q16'];
		$imp_points_risk=$_POST['imp_points_risk'];
		$name_assessor=$_POST['name_assessor'];
		$name_key_contact=$_POST['name_key_contact'];
		$contact_details=$_POST['contact_details'];
		
		$qr="INSERT INTO tbl_dtls_q3_last(loc_id, source_type, habit_name, risk_analysis_q1, risk_analysis_q2, risk_analysis_q3, risk_analysis_q4, risk_analysis_q5, risk_analysis_q6, risk_analysis_q7, risk_analysis_q8, risk_analysis_q9, risk_analysis_q10, risk_analysis_q11, risk_analysis_q12, risk_analysis_q13, risk_analysis_q14, risk_analysis_q15, risk_analysis_q16, imp_points_risk, name_assessor, name_key_contact, contact_details) VALUES ('$loc_id', '$src', '$habit', '$risk_q1', '$risk_q2', '$risk_q3', '$risk_q4', '$risk_q5', '$risk_q6', '$risk_q7', '$risk_q8', '$risk_q9', '$risk_q10', '$risk_q11', '$risk_q12', '$risk_q13', '$risk_q14', '$risk_q15', '$risk_q16', '$imp_points_risk', '$name_assessor', '$name_key_contact', '$contact_details')";	
		//echo $qr;
			$result=mysql_query($qr);
		if($result)
		{
			echo "success";		
		}
		else
		{
			echo "unsuccess";
		}
}		
else
{
	$fclick = false;
	$flag=0;
	$_SESSION['success_rain'] = 0;
}		
?>
<div align="center">
<form action="" method="post" enctype="multipart/form-data" name="questionnaire3_8" id="questionnaire3_8" onSubmit="window.close();">
	<table border="0" width="800" id="table1" cellspacing="0" cellpadding="0">
		<tr>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td bgcolor="#EEEEEE" height="20"><font color="#000000">&nbsp;
			<span style="font-weight: 700">
			<font face="Arial" style="font-size: 8.5pt">Risk Assessment &amp; 
			Analysis (For EachRain Water Tank) </font></span></font></td>
		</tr>
		<tr>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>
			<table width="100%" height="395" border="0" cellpadding="0" id="table12">
				<tr>
					<td width="58" align="center" height="29" bgcolor="#F7E6B7">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					S. No.</font></td>
					<td width="518" height="29" bgcolor="#F7E6B7">
					<p align="center">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					Question</font></td>
					<td width="133" height="29" bgcolor="#F7E6B7">
					<p align="center">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					Yes / No</font></td>
				</tr>
				<tr>
					<td width="58" height="36" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					1</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2331;&#2340; &#2325;&#2375; &#2346;&#2352;&#2367;&#2325;&#2381;&#2359;&#2375;&#2340;&#2381;&#2352; &#2350;&#2375;&#2306; &#2325;&#2367;&#2360;&#2368; &#2346;&#2381;&#2352;&#2325;&#2366;&#2352; &#2325;&#2366; &#2342;&#2370;&#2359;&#2367;&#2340; &#2357;&#2366;&#2340;&#2366;&#2357;&#2352;&#2339; &#2361;&#2376;?(&#2346;&#2380;&#2343;&#2375;,&#2343;&#2370;&#2354;,&#2325;&#2370;&#2396;&#2366;)</font></td>
					
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q1" id="risk_q1" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q1" id="risk_q1" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="25" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					2</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2346;&#2366;&#2344;&#2368; &#2325;&#2366; &#2349;&#2339;&#2381;&#2337;&#2366;&#2352;&#2339; &#2325;&#2352;&#2344;&#2375; &#2357;&#2366;&#2354;&#2375; &#2346;&#2366;&#2311;&#2346; &#2327;&#2306;&#2342;&#2375; &#2361;&#2376;&#2306; ?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q2" id="risk_q2" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q2" id="risk_q2" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="27" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					3</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2335;&#2376;&#2306;&#2325; &#2325;&#2375; &#2347;&#2367;&#2354;&#2381;&#2335;&#2352; &#2348;&#2377;&#2325;&#2381;&#2360; &#2350;&#2375;&#2306; &#2325;&#2379;&#2312; &#2340;&#2381;&#2352;&#2369;&#2335;&#2368; &#2361;&#2376;?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q3" id="risk_q3" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q3" id="risk_q3" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="34" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 9.5pt" face="Verdana" color="#000000">
					4</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2324;&#2352; &#2325;&#2379;&#2312; &#2360;&#2381;&#2352;&#2379;&#2340; &#2361;&#2376; &#2332;&#2367;&#2360;&#2360;&#2375; &#2327;&#2344;&#2381;&#2342;&#2366; &#2346;&#2366;&#2344;&#2368; &#2335;&#2376;&#2306;&#2325; &#2350;&#2375;&#2306; &#2310; &#2352;&#2361;&#2366; &#2361;&#2376;?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q4" id="risk_q4" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q4" id="risk_q4" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="49" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					5</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">&#2325;&#2381;&#2351;&#2366; &#2335;&#2376;&#2306;&#2325; &#2325;&#2368; &#2342;&#2368;&#2357;&#2366;&#2352;&#2379;&#2306; &#2324;&#2352; &#2360;&#2367;&#2352;&#2375; &#2350;&#2375;&#2306; &#2325;&#2379;&#2312; &#2326;&#2352;&#2366;&#2348;&#2368; &#2361;&#2376;?(&#2342;&#2352;&#2366;&#2352;&#2375;&#2306;) &#2332;&#2367;&#2360;&#2360;&#2375; &#2342;&#2370;&#2359;&#2367;&#2340; &#2332;&#2354; &#2335;&#2376;&#2306;&#2325; &#2350;&#2375;&#2306; &#2346;&#2381;&#2352;&#2357;&#2375;&#2358; &#2325;&#2352; &#2352;&#2361;&#2366; &#2361;&#2379; ?
					</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q5" id="risk_q5" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q5" id="risk_q5" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="36" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					6</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">&#2325;&#2381;&#2351;&#2366; &#2335;&#2379;&#2306;&#2335;&#2368; &#2335;&#2370;&#2335;&#2368; &#2361;&#2369;&#2312; &#2361;&#2376; &#2351;&#2366; &#2325;&#2379;&#2312; &#2309;&#2344;&#2381;&#2351; &#2350;&#2361;&#2340;&#2381;&#2357;&#2346;&#2370;&#2352;&#2381;&#2339; &#2326;&#2352;&#2366;&#2348;&#2368; &#2361;&#2376;?
					</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q6" id="risk_q6" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q6" id="risk_q6" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="33" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					7</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2335;&#2376;&#2306;&#2325; &#2325;&#2366; &#2347;&#2352;&#2381;&#2358; (&#2335;&#2379;&#2306;&#2335;&#2368; &#2325;&#2375; &#2344;&#2367;&#2330;&#2375;) &#2325;&#2381;&#2359;&#2340;&#2367;&#2327;&#2381;&#2352;&#2360;&#2381;&#2340; &#2309;&#2341;&#2357;&#2366; &#2327;&#2344;&#2381;&#2342;&#2366; &#2361;&#2376;?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q7" id="risk_q7" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q7" id="risk_q7" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="33" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					8</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2332;&#2354; &#2349;&#2339;&#2381;&#2337;&#2366;&#2352;&#2339; &#2325;&#2366; &#2325;&#2381;&#2359;&#2375;&#2340;&#2381;&#2352;  &#2309;&#2344;&#2369;&#2330;&#2367;&#2340; &#2344;&#2366;&#2354;&#2367;&#2323;&#2306; &#2342;&#2381;&#2357;&#2366;&#2352;&#2366; &#2349;&#2352;&#2366; &#2332;&#2366; &#2352;&#2361;&#2366; &#2361;&#2376;?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q8" id="risk_q8" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q8" id="risk_q8" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" height="33" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					9</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2335;&#2376;&#2306;&#2325; &#2346;&#2352;&#2367;&#2325;&#2381;&#2359;&#2375;&#2340;&#2381;&#2352; &#2350;&#2375;&#2306; &#2324;&#2352; &#2325;&#2379;&#2312; &#2342;&#2370;&#2359;&#2367;&#2340; &#2360;&#2381;&#2352;&#2379;&#2340; &#2361;&#2376; &#2351;&#2366; &#2332;&#2354; &#2360;&#2306;&#2327;&#2381;&#2352;&#2361;&#2339; &#2325;&#2381;&#2359;&#2375;&#2340;&#2381;&#2352; &#2361;&#2376;?(&#2332;&#2376;&#2360;&#2375; -&#2325;&#2370;&#2396;&#2366;-&#2325;&#2396;&#2325;&#2335;)</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q9" id="risk_q9" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q9" id="risk_q9" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					10</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 9.5pt" color="#000000">
					&#2325;&#2381;&#2351;&#2366; &#2348;&#2366;&#2354;&#2381;&#2335;&#2368; &#2325;&#2379; &#2320;&#2360;&#2375; &#2360;&#2381;&#2341;&#2366;&#2344; &#2346;&#2352; &#2346;&#2335;&#2325; &#2342;&#2367;&#2351;&#2366; &#2327;&#2351;&#2366; &#2361;&#2376; &#2332;&#2367;&#2360;&#2360;&#2375; &#2357;&#2361; &#2342;&#2370;&#2359;&#2367;&#2340; &#2361;&#2379; &#2332;&#2366;&#2351;&#2375;?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 9.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q10" id="risk_q10" value="YES">&#2361;&#2366;&#2305;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
						<font style="font-size: 9.5pt">
				  		<input type="radio" name="risk_q10" id="risk_q10" value="NO"> &#2344;&#2361;&#2368;&#2306;</font></font>
					</td>
				</tr>
				<!--<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					11</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					Can water, dirt or dust enter the well/borewell at the point 
					of attachment of handpump?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q11" id="risk_q11" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q11" id="risk_q11" value="NO"> No</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					12</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					Is apron missing, damaged or less than 1.85 m in diameter ?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q12" id="risk_q12" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q12" id="risk_q12" value="NO"> No</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					13</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					can waste water collect on apron ?</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q13" id="risk_q13" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q13" id="risk_q13" value="NO"> No</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					14</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					Do people regularly bath, and wash closth or cooking/ eating 
					uthnsils at the hand pump/GLR</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q14" id="risk_q14" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q14" id="risk_q14" value="NO"> No</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					15</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					Are villagers satisfied with PHED supply </font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q15" id="risk_q15" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q15" id="risk_q15" value="NO"> No</font></font>
					</td>
				</tr>
				<tr>
					<td width="58" align="center" bgcolor="#FDF9EE">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					16</font></td>
					<td width="518" bgcolor="#FDF9EE">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">
					Are there pvt TWs/OWs used by villagers for drinking water 
					supply</font></td>
					<td width="133" bgcolor="#FDF9EE" align="center">
						<font style="font-size: 8.5pt" face="Arial" color="#000000">
						<input type="radio" name="risk_q16" id="risk_q16" value="YES">Yes
						<font style="font-size: 8.5pt">
				  		<input type="radio" name="risk_q16" id="risk_q16" value="NO">No</font></font>
					</td>
				</tr>-->
			</table>
			</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>&nbsp;
			</td>
		</tr>
		<tr>
			<td bgcolor="#EEEEEE" height="20">
			<font face="Arial" color="#000000">
			<span style="font-size: 8.5pt; font-weight: 700">&nbsp;
			<span style="font-weight: 700; font-size:8.5pt">
			<font style="font-size: 8.5pt; font-weight:700"></font></span>Result 
			and Recommendations </span></font></td>
		</tr>
		<tr>
			<td>
			<table border="0" width="100%" id="table13" cellspacing="0" height="74">
				<tr>
					<td bgcolor="#F7E6B7">&nbsp;<font style="font-size: 8.5pt" face="Verdana" color="#000000">&nbsp; 
					The following important points of risk were noted</font></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">
					<p align="center">
					<textarea rows="5" name="imp_points_risk" id="imp_points_risk" cols="125" style="font-size: 8pt; font-family: Verdana; border-style: solid; border-width: 1px"></textarea></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;</td>
				</tr>
				<tr>
					<td bgcolor="#F7E6B7">&nbsp;
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					N<font style="font-size: 8.5pt">ame of th</font>e Assessor
					</font></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;<input type="text" name="name_assessor" id="name_assessor" size="45" style="font-size: 8pt; font-family: Verdana"></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;</td>
				</tr>
				<tr>
					<td bgcolor="#F7E6B7">&nbsp;
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">
					N<font style="font-size: 8.5pt">ame of th</font>e Key 
					Contact</font></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;<input type="text" name="name_key_contact" id="name_key_contact" size="45" style="font-size: 8pt; font-family: Verdana"></td>
				</tr>
				<tr>
					<td bgcolor="#F7E6B7">&nbsp;<font style="font-size: 8.5pt" face="Verdana" color="#000000"> 
					Contact Details&nbsp; </font></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;
					<textarea rows="5" name="contact_details" id="contact_details" cols="42" style="font-size: 8pt; font-family: Verdana; border-style: solid; border-width: 1px"></textarea></td>
				</tr>
				<tr>
					<td bgcolor="#FDF9EE">&nbsp;</td>
				</tr>
			</table>
			</td>
		</tr>
		<tr>
			<td>
			<table border="0" width="100%" id="table11" cellspacing="0" cellpadding="0">
				<tr>
					<td>&nbsp;</td>
				</tr>
			</table>
			</td>
		</tr>
		<tr>
			<td>&nbsp;
			</td>
		</tr>
		<tr>
			<td>
			<p align="center">
			<input type="submit" value="Submit" name="submit" style="font-size: 8pt; font-family: Verdana; border-style: solid; border-width: 1px"></td>
		</tr>
		<tr>
			<td>&nbsp;</td>
		</tr>
	</table>
	</form>
</div>
<!--</div>-->
</body>
</html>
